Thursday, December 23, 2004

How Far We Have Come...
New York Times article on the golden anniversary today of the first successful solid organ transplant:The Ultimate Gift: 50 Years of Organ Transplants
The first successful organ transplant recipient was a 23-year-old man from Northboro, Mass., named Richard Herrick, who had just been discharged from the Coast Guard.

On Dec. 23, 1954, he received a kidney from his healthy identical twin brother, Ronald, in an operation performed by Dr. Joseph E. Murray at what is now Brigham and Women's Hospital in Boston. Richard survived for eight years until the original kidney disease destroyed his new organ.

Mr. Herrick's surgery was a victory long in coming. The very first transplants were blood transfusions, procedures that became much safer after the discovery of blood groups in 1900. In 1905, doctors performed the first corneal transplant, and then moved on to solid organs.

But for many years, they had no real success. Beginning with the first attempted transplant of a human kidney in France in 1906, doctors performed about 40 kidney transplants, but all the patients died. In some early transplants, the donor kidney was placed not in the pelvis, as is now standard practice, but in areas like the arm or thigh.

In June 1950, a Chicago surgeon removed one of a woman's two failing cystic kidneys and gave her a healthy organ that functioned for at least 53 days. But the organ was rejected sometime in the next months.

Still, the woman lived five more years, probably because the donor organ survived long enough to allow her damaged kidney to recover partial function, Dr. Nicholas L. Tilney, also of Brigham and Women's, wrote in "Transplant: From Myth to Reality." But Mr. Herrick's is considered the first successful transplant because experts defined success as survival of a graft for at least a year.

In their struggle to make transplants work, the pioneers had to overcome the objections of antivivisectionists to conduct the animal experiments needed to develop the techniques for human transplants. They also knew that a failed operation could set the field back by decades, Dr. Murray said.

The radical nature of an operation to remove a healthy organ from a donor led Dr. Murray's team to seek support from religious, legal and community leaders. Nevertheless, critics accused the doctors of playing God. Dr. Starzl recalled how participants at scientific meetings lampooned his and other surgeons' first - and often disappointing - reports.

An effort for which Dr. Murray won a Nobel Prize.
From Dr. Starzl:
"The growth of transplantation from ground zero to its present state seems like a fairy tale, a fantasy that became reality because of the courage of our patients," said Dr. Thomas E. Starzl, a pioneering transplant surgeon who led the team that performed Mr. Phillips's operation and now is at the University of Pittsburgh. "The truth is that none of us in the 1950's remotely envisioned the height to which transplantation would rise and the way it has changed the face of medicine. Transplants have had trickle down effects on all aspects of society like acceptance of criteria for brain death, passage of anatomical gift acts and the growth of biomedical ethics."

What will the next fifty years hold?


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